Radiation maculopathy after proton beam therapy for uveal melanoma: Microvascular and structural alterations influencing visual acuity

Session Details

Session Title: Free Paper Session 15: Mixed Session

Session Date/Time: Friday 08/09/2017 | 16:30-18:00

Paper Time: 16:30

Venue: Room 117

First Author: : A.Matet SWITZERLAND

Co Author(s): :    A. Daruich   L. Zografos                          

Abstract Details

Purpose:

To analyze microvascular and structural changes in radiation maculopathy and their influence on visual acuity (VA), using optical coherence tomography (OCT) and OCT-Angiography (OCT-A).

Setting:

Retrospective observational case series from a tertiary referral centre.

Methods:

Consecutive patients with radiation maculopathy, ≥12 months after proton-beam irradiation for uveal melanoma, underwent fluorescein angiography (FA), OCT and OCT-A. Low-quality OCT-A acquisitions were excluded. Clinical parameters potentially affecting VA were recorded, including OCT-A-derived metrics: foveal avascular zone (FAZ) area, vascular density and local fractal dimension of the superficial (SCP) and deep capillary plexuses (DCP). Thirty-five non-irradiated fellow eyes served as controls.

Results:

Ninety-three patients were included. FAZ was larger, SCP/DCP capillary density and local fractal dimension were lower in the 35 irradiated versus 35 fellow eyes (P<.0001). Qualitative FA microvascular alterations were correlated to FAZ area and SCP/DCP density on OCT-A (P<.01). In a univariate analysis, worse VA was associated to macular detachment at presentation (P=.024), total macular irradiation (P=.0008), higher CMT (P=.019), higher absolute CMT variation (P<.0001), cystoid edema (P=.030), ellipsoid zone disruption (P=.002), larger FAZ (P<.0001), lower SCP (P=.001) and DCP capillary density (P<.0001), and lower SCP (P=.009) and DCP local fractal dimension (P<.0001). Two multivariate models with either capillary density or fractal dimension as covariate showed that younger age (P=.014/.017), ellipsoid zone disruption (P=.034/.019), larger FAZ (P=.0006/.002), and lower DCP density (P=.008) or DCP fractal dimension (P=.012) were associated with worse VA, respectively.

Conclusions:

VA of eyes with radiation maculopathy is influenced by several structural and microvascular factors, including FAZ area and DCP integrity.

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